[Primary prevention of sudden cardiac death implanted cardioverter defibrillator (ICD) versus antiarrhythmic drugs].
All patients with coronary heart disease (CHD) are at risk for sudden cardiac death (SCD) multiple factors in addition to reduced ejection fraction (EF) have been demonstrated to contribute to the risk for SCD after myocardial infarction (HI), these include the presence of non sustained ventricular tachycardia (NSVT), symptomatic heart failure (HF), and sustained monomorphic VT inducible by EP testing. The only specific antiarrhythmic treatment proved consistently is effective to reduce risk of SCD and total mortality is the ICD. ICD therapy is indicated to reduce the risk of SCD in 2 patient groups; patients whose LVEF is less than or equal to 35% as a result of prior MI and who have spontaneous NSVT and sustained monomorphic VT inducible by EP testing, and patients of and MI than occurred greated than or equal to 40 days earlier when HF (NYHA) functional class II or III symptoms) is present. Amiodarone therapy has been thought to be relatively safe in patients with prior MI who had symptomatic arrhythmias that required suppression. Although randomized trials have not demonstrated a survival benefit when empiric amiodarone is initiated early after MI, mortality was not increased, and arrhythmic deaths showed a consistent trend toward reduction with amiodarone treatment.
Iturralde Torres
Pedro
P
Departamento de Electrocardiología, Instituto Nacional de Cardiología "Ignacio Chávez", INCICH, Juan Badiano Núm 1, Col. Sección XVI Viaducto, Tlalpan 14080 México, DF.
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006801:Humans; D011322:Primary Prevention / Q000379:methods
D000889:Anti-Arrhythmia Agents